Healthcare Provider Details

I. General information

NPI: 1053313551
Provider Name (Legal Business Name): HAI-SHIUH M WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

IV. Provider business mailing address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7691
  • Fax: 330-743-8368
Mailing address:
  • Phone: 330-746-7691
  • Fax: 330-743-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35-039639
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: